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Salibian AA, Patel KM. Introduction to "Advances in Microsurgical Breast Reconstruction". Gland Surg 2024; 13:128-130. [PMID: 38455352 PMCID: PMC10915425 DOI: 10.21037/gs-22-562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Ara A Salibian
- Division of Plastic & Reconstructive Surgery, University of California Davis, Sacramento, CA, USA
- Division of Plastic & Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic & Reconstructive Surgery, University of California Davis, Sacramento, CA, USA
- Division of Plastic & Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Author Correction: Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:19969. [PMID: 37968383 PMCID: PMC10651834 DOI: 10.1038/s41598-023-47362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Salibian AA, Swerdlow MA, Kondra K, Patel KM. The Free Superficially Based Low-Abdominal Mini Flap for Oncoplastic Breast Reconstruction. Plast Reconstr Surg 2023; 152:959-962. [PMID: 36995194 DOI: 10.1097/prs.0000000000010466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
SUMMARY Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Ara A Salibian
- From the Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine
| | - Mark A Swerdlow
- Division of Plastic and Reconstructive Surgery, University of Southern California School of Medicine
| | - Katelyn Kondra
- Division of Plastic and Reconstructive Surgery, University of Southern California School of Medicine
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Cedars Sinai Medical Center
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:16087. [PMID: 37752170 PMCID: PMC10522584 DOI: 10.1038/s41598-023-42746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Shauly O, Olson B, Marxen T, Menon A, Losken A, Patel KM. Direct-to-implant versus autologous tissue transfer: A meta-analysis of patient-reported outcomes after immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:93-106. [PMID: 37329749 DOI: 10.1016/j.bjps.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The effect of immediate implant and autologous breast reconstruction on complication rates has been studied extensively; however, the patient-reported outcomes for these procedures during immediate, one-stage reconstruction has yet to be comprehensively investigated. OBJECTIVE This study compared the patient-reported outcomes for immediate implant reconstruction with those associated with immediate autologous reconstruction to determine the advantages and disadvantages for each modality from the patient's perspective. METHODS A literature search of PubMed between 2010 and 2021 was performed, and 21 studies containing patient-reported outcomes were selected for the analysis. A meta-analysis of patient-reported outcome scores was performed separately for immediate breast reconstruction using autologous tissue transfer and synthetic implants. RESULTS Nineteen manuscripts were included, representing data on a total of 1342 patients across all studies. The pooled mean of patients' satisfaction with their breasts was 70.7 (95% CI, 69.4-72.0) after immediate autologous reconstruction and 68.5 (95% CI, 67.1-69.9) after immediate implant reconstruction, showing a statistically significant difference in outcomes (p < 0.05). The pooled mean of patients' sexual well-being was 59.3 (95% CI, 57.8-60.8) after immediate autologous reconstruction and 62.8 (95% CI, 60.7-64.8) after immediate implant reconstruction (p < 0.01). The pooled mean of patients' satisfaction with their outcome was 78.8 (95% CI, 76.2-81.3) after immediate autologous reconstruction and 82.3 (95% CI, 80.4-84.1) after immediate implant reconstruction (p < 0.05). The results of each meta-analysis were summarized on forest plots depicting the distribution of patient-reported outcome scores from each study. CONCLUSIONS Immediate reconstruction with implants may have a similar or greater capacity to achieve patient satisfaction and improve patients' QoL compared to those associated with immediate reconstruction with autologous tissue transfer when both procedures are available.
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Affiliation(s)
- Orr Shauly
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Blade Olson
- University of Southern California, Keck School of Medicine, Division of Plastic and Reconstructive Surgery, CA, United States
| | - Troy Marxen
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States.
| | - Ambika Menon
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Albert Losken
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Ketan M Patel
- University of Southern California, Keck School of Medicine, Division of Plastic and Reconstructive Surgery, CA, United States
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Salibian AA, Swerdlow MA, Kondra K, Patel KM. Extreme Limb Salvage: The Thin SCIP Flap for Distal Amputation Coverage in Highly Comorbid Patients. Plast Reconstr Surg 2023:00006534-990000000-02097. [PMID: 37647504 DOI: 10.1097/prs.0000000000011030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Limb length preservation is correlated with overall survival. Successful free flap coverage of fore-, mid- and hind-foot amputations can prevent more proximal below-knee amputations but is challenging in patients with multiple comorbidities. The thin superficial circumflex iliac artery perforator (SCIP) flap is well-suited for these patients as it provides thin, pliable tissue from a favorable donor site. METHODS A retrospective review of all patients with distal amputations requiring coverage with a thin SCIP flap between 2016 to 2022 was performed. Patient demographics, amputation levels, and wound characteristics as well as flap and microsurgery details were analyzed. The primary outcome was limb salvage. Secondary outcomes included partial flap necrosis, flap revision rate and additional postoperative complications. RESULTS Thirty-two patients (mean age 57.3) underwent reconstruction of fore-, mid- and hindfoot amputations with thin SCIP flaps (mean follow-up 36 months). Twenty-eight patients (87.5%) had diabetes, 27 (84.4%) had peripheral artery disease and 15 (46.9%) were dialysis-dependent. Average flap size was 59.5cm2 and average flap thickness was 5.7mm. Successful limb salvage was achieved in 27 patients (84.3%). Three cases (9.4%) had total flap loss. Twenty-one flaps (65.6%) had partial necrosis of which 12 (57.1%) healed with conservative management and seven (33.3 %) healed after late revision. CONCLUSION The thin SCIP flap is a useful option for coverage of distal pedal amputations in patients with significant comorbidities. Despite higher rates of partial flap necrosis, free flap reconstruction allowed for high rates of limb salvage in a challenging patient population.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic & Reconstructive Surgery, UC Davis School of Medicine, Sacramento, CA
| | - Mark A Swerdlow
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - Katelyn Kondra
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Division of Plastic & Reconstructive Surgery, Cedars Sinai Medical Center, Los Angeles, CA
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Salibian AA, Patel KM. Microsurgery in oncoplastic breast reconstruction. Gland Surg 2023; 12:527-534. [PMID: 37200929 PMCID: PMC10186168 DOI: 10.21037/gs-22-561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
Oncoplastic breast reconstruction has allowed for the optimization of oncologic and reconstructive outcomes after breast-conserving surgery (BCS). Volume replacement procedures in oncoplastic reconstruction most commonly utilize regional pedicled flaps, though several studies have reported benefits to free tissue transfer for oncoplastic partial breast reconstruction in the immediate, delayed-immediate and delayed settings. Microvascular oncoplastic breast reconstruction is a useful technique in the appropriate patients with small-to-medium size breasts and larger tumor-to-breast ratios who desire to preserve breast size, those with a paucity of regional breast tissue and patients that wish to avoid chest wall and back scars. Several free flap options for partial breast reconstruction exist, including superficially-based abdominal flaps, medial thigh-based flaps, deep inferior epigastric artery perforator (DIEP) flaps and thoracodorsal artery-based flaps. However, special consideration should be given to preserving donor sites for potential future total autologous breast reconstruction with any flap choice that should be tailored to individual recurrence risk. Aesthetically placed incisions should take recipient vessel access into consideration which include the internal mammary vessels and perforators medially, and then intercostal, serratus branch and thoracodorsal vessels laterally. The utilization of a thin strip of lower abdominal tissue based on the superficial abdominal circulation allows for a well-concealed donor site with minimal morbidity and preservation of the abdominal donor site if future total autologous breast reconstruction is needed. Optimizing outcomes requires a team-based approach to appropriately design recipient and donor-site considerations while individualizing tumor and patient-specific plans.
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Affiliation(s)
- Ara A. Salibian
- Division of Plastic & Reconstructive Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ketan M. Patel
- Division of Plastic & Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Ramaiya N, Manchanda R, Chowdhuri MB, Yadava N, Dey R, Kumar A, Shah K, Patel S, Jadeja KA, Patel KM, Kumar R, Aich S, Pathak SK, Tanna RL, Ghosh J. Initial results from near-infrared spectroscopy on ADITYA-U tokamak. Rev Sci Instrum 2022; 93:113552. [PMID: 36461425 DOI: 10.1063/5.0101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Paβ and Paγ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 1016 and 1.9 × 1016 particles cm-2 s-1 from neutral hydrogen lines Hα and Paβ, respectively, and the C influx value is found to be 3.5 × 1015 and 2.9 × 1015 particles cm-2 s-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.
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Affiliation(s)
- N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad 382 481, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar 382 007, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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9
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Salibian AA, Olson B, Shauly O, Patel KM. Oncoplastic breast reconstruction: Principles, current techniques, and future directions. J Surg Oncol 2022; 126:450-459. [PMID: 35452129 DOI: 10.1002/jso.26897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
Abstract
Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Blade Olson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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Vartanian ED, Patel KM. Reply: The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation? J Surg Oncol 2021; 124:1571. [PMID: 34664270 DOI: 10.1002/jso.26715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Emma D Vartanian
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA.,Keck School of Medicine of USC, Los Angeles, California, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA.,Keck School of Medicine of USC, Los Angeles, California, USA
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Shauly O, Hershenhouse KS, Mayfield CK, Thomas I, Patel KM, Seruya M, Gould DJ. Crowd-sourcing public perceptions of endoscopic versus open carpal tunnel release. Eur J Plast Surg 2021. [DOI: 10.1007/s00238-021-01796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ebner PJ, Bick KJ, Emamaullee J, Stanton EW, Gould DJ, Patel KM, Genyk Y, Sher L, Carey JN. Microscope-Assisted Arterial Anastomosis in Adult Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Outcomes. J Reconstr Microsurg 2021; 38:306-312. [PMID: 34428807 DOI: 10.1055/s-0041-1732349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) has expanded the availability of liver transplant but has been associated with early technical complications including the devastating complication of hepatic artery thrombosis (HAT), which has been reported to occur in 14% to 25% of LDLT using standard anastomotic techniques. Microvascular hepatic artery reconstruction (MHAR) has been implemented in an attempt to decrease rates of HAT. The purpose of this study was to review the available literature in LDLT, specifically related to MHAR to determine its impact on rates of posttransplant complications including HAT. METHODS A systematic review was conducted using PubMed/Medline and Web of Science. Case series and reviews describing reports of microscope-assisted hepatic artery anastomosis in adult patients were considered for meta-analysis of factors contributing to HAT. RESULTS In all, 462 abstracts were screened, resulting in 20 studies that were included in the meta-analysis. This analysis included 2,457 patients from eight countries. The pooled rate of HAT was 2.20% with an overall effect size of 0.00906. CONCLUSION Systematic literature review suggests that MHAR during LDLT reduces vascular complications and improves outcomes posttransplant. Microvascular surgeons and transplant surgeons should collaborate when technical challenges such as small vessel size, short donor pedicle, or dissection of the recipient vessel wall are present.
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Affiliation(s)
- Peggy J Ebner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Katherine J Bick
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Eloise W Stanton
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, California.,Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
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13
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Shah K, Ghosh J, Shukla G, Chowdhuri MB, Manchanda R, Yadava N, Ramaiya N, Jadeja KA, Patel KM, Tanna RL, Mayya KBK. Observations of visible argon line emissions and its spatial profile from Aditya-U tokamak plasma. Rev Sci Instrum 2021; 92:053548. [PMID: 34243287 DOI: 10.1063/5.0043877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
The spectroscopic studies of medium and high Z impurities have been the subject of interest in fusion research due to their role in mitigating plasma disruption and reducing heat load on the plasma facing components. Line emissions from these impurities provide the rotation velocity and ion temperature measurements along with the understanding of the overall impurity behavior in plasma. In the Aditya-U tokamak, the spatially resolved Ar II line emissions have been observed using a high resolution multi-track spectroscopic diagnostic consisting of a 1 m Czerny-Turner spectrometer coupled with a charge coupled device (CCD) detector using seven lines of sight viewing plasma tangentially along the toroidal direction. The spatially resolved Ar II lines at 458.96 nm have been observed. The singly ionized Ar emission peaks at the radial location of ρ = 0.8 of the plasma having a minor radius of 25 cm. Moreover, a 0.5 m UV-visible spectrometer coupled with a CCD detector and having a line of sight passing through the plasma midplane from the radial port was used to record visible Ar survey spectra within the 670-810 nm wavelength range, and all these lines have been identified for further analysis.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N Yadava
- The National Institute of Engineering, Mysuru 570 008, Karnataka, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
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14
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Murphy GA, Singh-Moon RP, Rowe VL, Patel KM, Mazhar A, Cuccia DJ, Armstrong DG. Steal syndrome from a superficial circumflex iliac perforator artery flap in a patient with a hypoplastic posterior tibial artery and severe diabetic peripheral artery disease. J Surg Case Rep 2021; 2021:rjab067. [PMID: 33777352 PMCID: PMC7984850 DOI: 10.1093/jscr/rjab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
The use of free flaps in lower extremity reconstructive surgery has seen growing adoption for treating tissue loss in patients with diabetes mellitus and peripheral artery disease as a means for limb preservation. The superficial circumflex iliac perforator artery (SCIP) flap is one of the most commonly utilized flaps in foot reconstruction and has demonstrated benefits over amputation. Patients with impaired vascular and neurologic function are predisposed to complications following lower extremity reconstructive surgery, particularly ischemia in the angiosomes of the arteries used for flap anastomosis. We present the case of a patient who underwent successful SCIP flap reconstruction of the calcaneus but developed gangrene in the forefoot region supplied by a hypoplastic posterior tibial artery in subsequent months. The changes in tissue oxygenation and hemoglobin distribution of the foot are shown using spatial frequency domain imaging throughout the flap healing process and eventual tissue necrosis.
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Affiliation(s)
- Grant A Murphy
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Vincent L Rowe
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amaan Mazhar
- Department of Research and Development, Modulim, Irvine, CA, USA
| | - David J Cuccia
- Department of Research and Development, Modulim, Irvine, CA, USA
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Vartanian ED, Lo AY, Hershenhouse KS, Jacob L, Patel KM. The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation? J Surg Oncol 2021; 123:1215-1231. [PMID: 33621375 DOI: 10.1002/jso.26422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/11/2022]
Abstract
As the sophistication of microsurgical breast reconstruction continues to evolve, plastic surgeons are focusing on techniques to improve functional and psychosocial outcomes for patients, including breast sensation. Interest in neurotization of breast flaps, among both patients and surgeons, has grown significantly in recent years. This study aimed to review the outcomes of neurotization across autologous flap reconstructions, to provide a comprehensive analysis of the efficacy of this technique in improving postoperative sensory recovery.
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Affiliation(s)
- Emma D Vartanian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Andrea Y Lo
- Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Laya Jacob
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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16
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Roubaud MS, Carey JN, Vartanian E, Patel KM. Breast reconstruction in the high-risk population: current review of the literature and practice guidelines. Gland Surg 2021; 10:479-486. [PMID: 33634005 DOI: 10.21037/gs-2020-nfbr-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "high-risk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.
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Affiliation(s)
- Margaret S Roubaud
- Department of Plastic and Reconstructive Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph N Carey
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Emma Vartanian
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
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17
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Ciudad P, Agko M, Patel KM, Lo Torto F, Forte AJ, Chen HC. A single-stage triple-inset vascularized gastroepiploic lymph node transfers for the surgical treatment of extremity lymphedema. Microsurgery 2020; 41:97-99. [PMID: 33340162 DOI: 10.1002/micr.30696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/23/2020] [Accepted: 12/04/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.,Division of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taiwan
| | - Mouchammed Agko
- Section of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ketan M Patel
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Federico Lo Torto
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto, Italy
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Hung-Chi Chen
- Division of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taiwan
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18
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Hershenhouse KS, Bick K, Shauly O, Kondra K, Ye J, Gould DJ, Patel KM. "Systematic review and meta-analysis of immediate versus delayed autologous breast reconstruction in the setting of post-mastectomy adjuvant radiation therapy". J Plast Reconstr Aesthet Surg 2020; 74:931-944. [PMID: 33423976 DOI: 10.1016/j.bjps.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/03/2020] [Accepted: 11/22/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Immediate post-mastectomy autologous breast reconstruction in breast cancer patients requiring post-mastectomy radiation therapy (PMRT) minimizes the number of operations that patients must undergo and alleviates the psychological impact of living without a breast. However, the safety and impact of radiation on the reconstructed breast remains to be established. This study aimed to compare immediate versus delayed autologous reconstruction in the setting of PMRT to determine the optimal sequencing of reconstruction and adjuvant radiation. METHODS A systematic review of the literature identified 292 studies meeting criteria for full-text review, 44 of which underwent meta-analysis. This represented data on 1,927 immediate reconstruction (IR) patients and 1,546 delayed reconstruction (DR) patients (3,473 total patients). Early complications included flap loss, fat necrosis, thrombosis, seroma, hematoma, infection, and skin dehiscence. Late complications included fibrosis or contracture, severe asymmetry, hyperpigmentation, and decreased flap volume. RESULTS Immediate breast reconstruction did not demonstrate significantly increased complication rates. Reported mean complication rates in IR versus DR groups, respectively, were fat necrosis 14.91% and 8.12% (p = 0.076), flap loss 0.99% and 1.80% (p = 0.295), hematoma 1.91% and 1.14% (p = 0.247), infection 11.66% and 4.68% (p = 0.155), and thrombosis 1.51% and 3.36% (p = 0.150). Seroma rates were significantly lower in the immediate cohort at 2.69% versus 10.57% in the delayed cohort (p = 0.042). CONCLUSION Complication rates are comparable between immediate and delayed breast reconstruction in the setting of PMRT. Given the patient benefits incurred by an IR algorithm, immediate autologous breast reconstruction should be considered as a viable treatment option in patients requiring PMRT.
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Affiliation(s)
| | - Katherine Bick
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Orr Shauly
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Katelyn Kondra
- Department of Surgery, Keck Hospital of USC, Los Angeles, California, USA
| | - Jason Ye
- Radiation Oncology, Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, California, USA.
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19
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Lo AY, Yu RP, Raghuram A, Khim P, Wang S, Manoukian HL, Johnson M, Schooler W, Carey J, Patel KM, Baker RY, Wong AK. Patient Characteristics Associated with Free Nipple Graft Reduction Mammoplasty. Cureus 2020; 12:e9063. [PMID: 32782881 PMCID: PMC7414379 DOI: 10.7759/cureus.9063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Surgical approaches for reduction mammoplasty most commonly incorporate a parenchymal vascular pedicle. For patients with larger breasts where pedicle viability may be compromised due to excessive length, the free nipple graft (FNG) technique provides a safe alternative. Criteria for whether a patient should undergo a FNG remains controversial due to variable reports in the literature with small sample sizes and inherent surgeon-dependent bias. To address this, we sought to investigate perioperative factors associated with performing FNGs at our institution in order to better elucidate specific indications for this surgery. Methods: A retrospective chart review was performed for 323 patients who underwent a reduction mammoplasty from August 2009 to July 2019 at Keck Hospital and LAC+USC Medical Center. Data regarding patient demographics, comorbidities, pre-operative breast characteristics, and post-operative complications were extracted. Studentʼs t-test, Fisherʼs exact test, and logistic regression were performed in R. Results: Of 323 patients, 15 received an FNG. Independent variables analyzed included: age, body mass index (BMI), obesity, smoking, diabetes, hypertension, surgical indication, sternal notch-to-nipple length, nipple-to-inframammary fold length, and weight of breast specimens removed. BMI, obesity, gigantomastia, and weight of specimen resected were significantly associated with use of the FNG (p < 0.001, p < 0.05, p < 0.0001, p < 0.0001, respectively). Regression analysis revealed that patients who had an average of more than 1500 g of tissue removed from each breast were 1.41 (95% CI: 1.17-1.71, p<0.001) times more likely to undergo an FNG procedure than those who had less than 1500 g of tissue removed. Demographic data and breast characteristics, such as notch-to-nipple length and nipple-to-inframammary fold length, were not significantly associated. Conclusion: Total weight of the breast specimens removed and BMI were significantly associated with the FNG technique. Removing more than 1500 g gof total breast tissue was also significantly correlated. These findings may guide surgeons during the decision-making process of when to use an FNG.
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Affiliation(s)
- Andrea Y Lo
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Roy P Yu
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Anjali Raghuram
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Phillip Khim
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Sarah Wang
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Haig L Manoukian
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Maxwell Johnson
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Wesley Schooler
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Joseph Carey
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Ketan M Patel
- Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Regina Y Baker
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Alex K Wong
- Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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20
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Abstract
Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Cameron Hassani
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Khoa Tran
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Suzanne L Palmer
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Ketan M Patel
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
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21
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Squitieri L, Rasmussen PW, Patel KM. An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection. J Surg Oncol 2020; 121:1175-1178. [PMID: 32207151 DOI: 10.1002/jso.25902] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Prophylactic lymphovenous anastomosis (LVA) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on overall healthcare costs has not been adequately studied and insurance reimbursement for lymphedema treatment is limited resulting in substantial out-of-pocket patient expenses. METHODS We performed a cost-minimization decision analysis from the societal perspective to assess two different patient scenarios: (a) mastectomy with ALND alone, (b) mastectomy with ALND and prophylactic LVA. RESULTS The annual cost of lymphedema-related care is estimated to be $5,691.88 ($3,160.52 direct, $2,531.36 indirect). If all patients undergoing mastectomy with ALND undergo prophylactic LVA, the average expected lifetime cost per patient in the entire population (whether or not they develop lymphedema) is approximately $6,295.61, compared to $13,942.26 if no patients in the same population receive prophylactic LVA. CONCLUSIONS Prophylactic LVA is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7,646.65 (45.2%) cost saving per patient over the course of their lifetime.
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Affiliation(s)
- Lee Squitieri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Petra W Rasmussen
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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22
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Muthukumar K, Patel KM, Mohapatra D, Padh B, Reddy BR. Selective recovery of vanadium as AMV from calcium vanadate sludge by direct AS leaching process: An industrial approach. Waste Manag 2020; 102:815-822. [PMID: 31812833 DOI: 10.1016/j.wasman.2019.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/20/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
Generation of calcium vanadate waste sludge their management and treatment.is one of the major problem of metal processing industry. In this paper, we have proposed a simple process for the selective recovery of vanadium as ammonium metavanadate (AMV) from the calcium vanadate sludge using ammonium sulphate (AS) as a leaching agent. Under the optimum leaching condition (pH-7.5, temperature-80 °C, time-1 h, AS reagent-0.5 M) it is possible to leach out 82% of V values from the calcium vanadate sludge. The overall recovery of V is 81% with 98.5% AMV product purity. The AMV product quality from AS leach process has been compared with conventional H2SO4 leach process. The proposed process has major advantages such as, better economic benefits, less chemical consumption, minimum effluent recycling and less waste generation.
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Affiliation(s)
- K Muthukumar
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - K M Patel
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - D Mohapatra
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
| | - Bharat Padh
- Technology Centre, R&D Department, Rubamin Ltd., Halol 389350, India
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23
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Stoneburner J, Shauly O, Carey J, Patel KM, Stevens WG, Gould DJ. Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons. Aesthetic Plast Surg 2020; 44:97-113. [PMID: 31667549 DOI: 10.1007/s00266-019-01529-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/14/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated. OBJECTIVES The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis. METHODS PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed. RESULTS The pooled rates of graft survival were 84.98% (95% CI 78.90-91.06) using micrografts and 93.11% (95% CI 91.93-94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12-97.20) using micrografts and 86.25% (95% CI 74.00-98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64-96.76) using micrografts and 97.00% (95% CI 92.48-100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59-100.0) using micrografts and 88.70% (95% CI 66.49-100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts. CONCLUSION Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jacqueline Stoneburner
- Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Orr Shauly
- Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Joseph Carey
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA
| | - W Grant Stevens
- Marina Plastic Surgery, Marina Plastic Surgery Associates, 4644 Lincoln Blvd., Suite 552, Marina Del Rey, CA, 90292, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA.
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Perrault DP, Lee GK, Bouz A, Sung C, Yu R, Pourmoussa AJ, Park SY, Kim GH, Jiao W, Patel KM, Hong YK, Wong AK. Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps. PLoS One 2020; 15:e0227599. [PMID: 31923917 PMCID: PMC6954070 DOI: 10.1371/journal.pone.0227599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/23/2019] [Indexed: 01/17/2023] Open
Abstract
Vascularized lymph node transfer (VLNT) is a promising treatment modality for lymphedema; however, how lymphatic tissue responds to ischemia has not been well defined. This study investigates the cellular changes that occur in lymph nodes in response to ischemia and reperfusion. Lymph node containing superficial epigastric artery-based groin flaps were isolated in Prox-1 EGFP rats which permits real time identification of lymphatic tissue by green fluorescence during flap dissection. Flaps were subjected to ischemia for either 1, 2, 4, or 8 hours, by temporarily occluding the vascular pedicle. Flaps were harvested after 0 hours, 24 hours, or 5 days of reperfusion. Using EGFP signal guidance, lymph nodes were isolated from the flaps and tissue morphology, cell apoptosis, and inflammatory cytokines were quantified and analyzed via histology, immunostaining, and rtPCR. There was a significant increase in collagen deposition and tissue fibrosis in lymph nodes after 4 and 8 hours of ischemia compared to 1 and 2 hours, as assessed by picrosirius red staining. Cell apoptosis significantly increased after 4 hours of ischemia in all harvest times. In tissue subject to 4 hours of ischemia, longer reperfusion periods were associated with increased rates of CD3+ and CD45+ cell apoptosis. rtPCR analysis demonstrated significantly increased expression of CXCL1/GRO-α with 2 hours of ischemia and increased PECAM-1 and TNF-α expression with 1 hour of ischemia. Significant cell death and changes in tissue morphology do not occur until after 4 hours of ischemia; however, analysis of inflammatory biomarkers suggests that ischemia reperfusion injury can occur with as little as 2 hours of ischemia.
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Affiliation(s)
- David P. Perrault
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Gene K. Lee
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Antoun Bouz
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Cynthia Sung
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Roy Yu
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Austin J. Pourmoussa
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Sun Young Park
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Gene H. Kim
- Departments of Pathology and Dermatology, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Wan Jiao
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Young-Kwon Hong
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Alex K. Wong
- Division of Plastic and Reconstructive Surgery and Department of Surgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
- * E-mail:
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Hershenhouse KS, Shauly O, Gould DJ, Patel KM. Meningeal Lymphatics: A Review and Future Directions From a Clinical Perspective. Neurosci Insights 2019; 14:1179069519889027. [PMID: 32363346 PMCID: PMC7176397 DOI: 10.1177/1179069519889027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022] Open
Abstract
The recent discovery of lymphatic vessels in the meningeal layers calls into question the known mechanisms of fluid and macromolecule homeostasis and immunoregulation within the central nervous system. These meningeal lymphatic vessels and their potential role in the pathophysiology of neurological disease have become a rapidly expanding area of research, with the hopes that they may provide a novel therapeutic target in the treatment of many devastating conditions. This article reviews the current state of knowledge surrounding the anatomical structure of the vessels, their functions in fluid and solute transport and immune surveillance, as well as their studied developmental biology, relationship with the novel hypothesized “glymphatic” system, and implications in neurodegenerative disease in animal models. Furthermore, this review summarizes findings from the human studies conducted thus far regarding the presence, anatomy, and drainage patterns of meningeal lymphatic vessels and discusses, from a clinical perspective, advancements in both imaging technologies and interventional methodologies used to access ultrafine peripheral lymphatic vessels.
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Affiliation(s)
- Korri S Hershenhouse
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA, USA
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Choi KJ, Brown AM, Pham CH, Patel SV, Patel KM, Carey J. Current Considerations of Breast Implant–Associated Anaplastic Large Cell Lymphoma in Breast Surgery: a Systematic Review. Curr Breast Cancer Rep 2019. [DOI: 10.1007/s12609-019-00342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Shauly O, Gould DJ, Patel KM. Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy for Chronic Migraine Headaches. Aesthet Surg J 2019; 39:NP462-NP470. [PMID: 30868158 DOI: 10.1093/asj/sjz069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common treatments for chronic migraine headaches include injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short term, and lifelong treatment is often necessary. In contrast, surgical decompression of migraine trigger sites accomplishes the same goal yet demonstrates successful long-term elimination of chronic migraines. OBJECTIVES Our primary objective was to perform a cost-utility analysis to determine which patients would benefit most from available treatment options in a cost-conscious model. METHODS A cost-utility analysis was performed, taking into consideration costs, probabilities, and health state utility scores of various interventions. RESULTS Injection therapy offered a minor improvement in quality-adjusted life-years (QALYs) compared with surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression: injection treatment was estimated to cost $106,887.96 more than surgery. The results of our cost-utility analysis thus conferred a positive incremental cost-utility ratio of $178,163.27 in favor of surgical decompression. CONCLUSIONS Surgery provides a durable intervention and has been shown in this study to be extremely cost effective despite a very minor QALY deficit compared with injection therapy. If patients are identified who require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.
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Affiliation(s)
- Orr Shauly
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
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28
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Mayfield CK, Gould DJ, Wong A, Patel KM, Carey J. Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction. Am Surg 2019; 85:1113-1117. [PMID: 31657305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although recommendations help guide surgeons' mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.
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Abstract
Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.
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Affiliation(s)
- Cory K. Mayfield
- Keck School of Medicine of the University of Southern California, Los Angeles, California and
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Alex Wong
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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Iker E, Mayfield CK, Gould DJ, Patel KM. Characterizing Lower Extremity Lymphedema and Lipedema with Cutaneous Ultrasonography and an Objective Computer-Assisted Measurement of Dermal Echogenicity. Lymphat Res Biol 2019; 17:525-530. [DOI: 10.1089/lrb.2017.0090] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emily Iker
- Lymphedema Center in Santa Monica, Santa Monica, California
| | - Cory K Mayfield
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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Gould DJ, El-Sabawi B, Goel P, Badash I, Colletti P, Patel KM. Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema. J Reconstr Microsurg 2019; 36:136-141. [DOI: 10.1055/s-0039-1697904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the two entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population.
Methods Patients with lipedema receiving lymphoscintigraphy between January 2015 and October 2017 were included. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan's transport index (TI) was utilized to assess lymphatic flow in patient's lower extremities (LEs).Scores ranged from 0 to 45, with values > 10 denoting pathologic lymphatic transport.
Results A total of 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 years and mean body mass index was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in five patients (26.3%), stage 2 in four patients (21.1%), stage 3 in four patients (21.1%), and stage 4 in six patients (31.6%). The mean TI for all extremities was 12.5; 24 (63.2%) LEs had a pathologic TI, including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p = 0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (standard deviation +7.96).
Conclusion Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.
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Affiliation(s)
- Daniel J. Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Bassim El-Sabawi
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Pedram Goel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Patrick Colletti
- Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
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Gould DJ, Siddiqi I, Carey J, Patel KM, Shauly O. Response to "Gluteal Implant-Associated Anaplastic Large Cell Lymphoma (ALCL) is Distinct From Systemic ALCL ALK Negative in a Patient With Gluteal Implants". Aesthet Surg J 2019; 39:NP443. [PMID: 31504148 DOI: 10.1093/asj/sjz219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniel J Gould
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Imran Siddiqi
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
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Abstract
Thin flaps, a modification of traditional flaps that minimize the need for debulking and revision, offer unique advantages in the field of lower limb reconstruction. Advances in the field of microsurgery have made this streamlined method of reconstruction a viable solution for soft tissue coverage in patients with both trauma and nonhealing wounds. Better understanding of anatomy has allowed for flap harvest above the fascia level and the Scarpal plane. These modifications allow for flap transfer with thicknesses more comparable to the native anatomy of the lower leg, ankle, and foot. Flap survival is comparable to traditional techniques with greater potential for improved patient-centered outcomes.
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Affiliation(s)
- Peggy J Ebner
- Division of Plastic and Reconstructive Surgery, Keck Hospital of University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck Hospital of University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck Hospital of University of Southern California, Los Angeles, California
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Azadgoli B, Gould DJ, Vartanian E, Patel KM. The Public's Perception on Breast and Nipple Reconstruction: A Crowdsourcing-Based Assessment. Aesthet Surg J 2019; 39:NP370-NP376. [PMID: 30329011 DOI: 10.1093/asj/sjy281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Breast reconstruction outcomes have traditionally been measured by evaluating the opinions of patients and surgeons. OBJECTIVES Our goal was to assess the views of the general public. METHODS A survey was designed and distributed through a crowdsourcing website called Amazon Mechanical Turk. Questions assessed participant demographics, personal experience with breast reconstruction, perceptions on breast reconstruction, and opinions regarding aesthetics results. Responses were analyzed using chi-square test. RESULTS A total of 992 responses were collected. Most participants were female (56.1%), white (32.1%), aged 30 to 39 years (40.4%), and had a bachelor's degree (42.0%). A total of 44.2% had personal experience with breast reconstruction and 25.8% with nipple reconstruction. Several aesthetic and reconstructive factors were significantly favored over others across sex, ethnicity, age group, education level, and personal experience with breast reconstruction. For instance, women were more likely to prefer reconstructed nipples (P < 0.0001), view a breast without a nipple as complete (P = 0.024) and place less importance on nipple shape (P = 0.002). Additionally, those who personally experienced nipple reconstruction were willing to undergo more procedures for a complete nipple-areola complex (P < 0.0001), to increase aesthetic results (P = 0.018), and to increase chances of nipple survival (P = 0.002). CONCLUSIONS Crowdsourcing can be useful in plastic surgery and has helped identify several key findings. The importance of the nipple in reconstruction has been validated; almost three-quarters of respondents did not view a breast without a nipple as complete. The aesthetic preferences seem to support bilateral nipple-sparing reconstruction when possible. Most importantly, the respondents helped elucidate key differences in perception of aesthetic outcomes.
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Affiliation(s)
- Beina Azadgoli
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Emma Vartanian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Ebner PJ, Liu A, Gould DJ, Patel KM. Breast implant-associated anaplastic large cell lymphoma, a systematic review and in-depth evaluation of the current understanding. J Surg Oncol 2019; 120:573-577. [PMID: 31373010 DOI: 10.1002/jso.25626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell neoplasm that arises in the capsule around breast implants. While an association with implants has been proposed, no causal link has been identified and the pathophysiology and natural history of BIA-ALCL remain unknown. A literature review of 391 articles was performed to assess the current understanding of BIA-ALCL and to provide a balanced and unbiased view of the current controversy surrounding the disease.
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Affiliation(s)
- Peggy J Ebner
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Alice Liu
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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Badash I, Shauly O, Lui CG, Gould DJ, Patel KM. Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques. Clin Med Insights Ear Nose Throat 2019; 12:1179550619865278. [PMID: 31384136 PMCID: PMC6657122 DOI: 10.1177/1179550619865278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher G Lui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Gould DJ, Carey J, Shauly O, Patel KM, Siddiqi I. Response to "No Proven Association Between Anaplastic Large Cell Lymphoma (ALCL) and Textured Buttock Implants". Aesthet Surg J 2019; 39:368-369. [PMID: 31242278 DOI: 10.1093/asj/sjz168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniel J Gould
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Imran Siddiqi
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
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Nalamlieng MD, Gould DJ, Patel KM. Ultrathin Free Flaps to the Foot and Ankle: New Options for Optimal Soft Tissue Coverage and Functional Contour. J Foot Ankle Surg 2019; 58:802-806. [PMID: 30962110 DOI: 10.1053/j.jfas.2018.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Indexed: 02/03/2023]
Abstract
Soft tissue defects and chronic wounds around the foot and ankle can prove difficult to reconstruct using conventional techniques. Traditional flaps used for coverage in this region can result in the need for future debulking, shoe gear modifications, donor site morbidity, decreased function, and scarring. Successful reports of ultrathin free flaps harvested along suprafascial planes have yet to be described in the foot and ankle literature. We present 2 cases of ultrathin flaps used for foot and ankle defects that provide optimal contour while not limiting anatomic function. The resultant functional outcomes and contour shown by both flaps underscore the benefit of a thin and pliable flap in this region.
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Affiliation(s)
| | - Daniel J Gould
- Surgeon, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Ketan M Patel
- Associate Professor and Surgeon, University of Southern California Keck School of Medicine, Los Angeles, CA.
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Shauly O, Gould DJ, Siddiqi I, Patel KM, Carey J. The First Reported Case of Gluteal Implant-Associated Anaplastic Large Cell Lymphoma (ALCL). Aesthet Surg J 2019; 39:NP253-NP258. [PMID: 30768141 DOI: 10.1093/asj/sjz044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Anaplastic large-cell lymphoma (ALCL) is a very rare but life-threatening complication that has largely been demonstrated to be associated with breast implants (BIA-ALCL). Patients are at risk of BIA-ALCL with the placement of breast implants for either cosmetic or reconstructive purposes, with the highest risks associated with textured breast implants. In the past decade, an increasing number of publications have focused on BIA-ALCL, but there has yet to be a reported case outside of the breast. Here, we describe a unique instance of gluteal implant-associated ALCL (GIA-ALCL) in a middle-aged woman. The patient received bilateral textured silicone gluteal implants only a year prior to her diagnosis of GIA-ALCL. The patient later presented to the Plastic and Reconstructive Surgery Department at our institution with ulceration at the site of her gluteal implants. Unfortunately, her condition deteriorated before explanation could be performed. Biopsy of a left lung mass demonstrated "hallmark" cells of ALCL ("horseshoe"-shaped nuclei). The diagnosis was verified by immunohistochemical testing that revealed expression of CD30, CD4, CD43, BCL6, Perforin, and Ki67 in a population of abnormal cells. The goals of this case report are thus to demonstrate that all patients undergoing implantation of textured silicone implants are at risk of developing ALCL and to provide evidence for the possible new diagnosis of GIA-ALCL. Level of Evidence: 5.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biopsy
- Body Contouring/adverse effects
- Body Contouring/instrumentation
- Buttocks/diagnostic imaging
- Buttocks/surgery
- Fatal Outcome
- Female
- Humans
- Lung/diagnostic imaging
- Lung/pathology
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/etiology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, Large-Cell, Anaplastic/therapy
- Magnetic Resonance Imaging
- Middle Aged
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/pathology
- Prostheses and Implants/adverse effects
- Silicone Gels/adverse effects
- Tomography, X-Ray Computed
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Affiliation(s)
- Orr Shauly
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Imran Siddiqi
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Joseph Carey
- Keck Hospital of University of Southern California, Los Angeles, CA
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Shauly O, Gould DJ, Patel KM. Microtexture and the Cell/Biomaterial Interface: A Systematic Review and Meta-Analysis of Capsular Contracture and Prosthetic Breast Implants. Aesthet Surg J 2019; 39:603-614. [PMID: 30124780 DOI: 10.1093/asj/sjy178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of textured breast implants over smooth implants has been widely shown to have a lower incidence of capsular contracture. However, the impact of micropatterning techniques on the incidence of postoperative patient morbidity has not been comprehensively investigated. OBJECTIVES The authors sought to examine the incidence of capsular contracture, seroma, and implant rippling among the 3 major micropatterning techniques applied in the manufacturing of textured breast implants. METHODS Literature searches of PubMed/Medline and Embase between 1995 and 2017 were performed, and 19 studies were selected for analysis. Data from each study were extracted into a form including mean age, study design, population size, mean follow-up, number of capsular contracture cases, number of seroma cases, and number of rippling cases. Meta-analysis was performed separately for studies that included capsular contracture rates for foam textured implants, imprinted textured implants, and salt-loss textured implants. RESULTS The pooled rate of capsular contracture rates in primary augmentation patients was 3.80% (95% CI, 2.19-5.40) for imprinted textured implants, 4.90% (95% CI, 3.16-6.64) for foam textured implants, 5.27% (95% CI, 3.22-7.31) for salt-loss textured implants, and 15.56% (95% CI, 13.31-18.16) for smooth implants. The results of each meta-analysis were summarized on a forest plot depicting the distribution of capsular contracture rates from each study. CONCLUSIONS Micropatterning of prosthetic implants could drastically reduce postoperative patient morbidity given the advent of recent technologies that allow for more detailed texturing of implant surfaces. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Orr Shauly
- University of Southern California, Los Angeles, CA
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41
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Vartanian E, Gould DJ, Lee SW, Patel KM. Response to Dr. Gips' Letter to the Editor. Ann Plast Surg 2019; 82:591. [DOI: 10.1097/sap.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shauly O, Gould DJ, Patel KM. The Public's Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study. Aesthet Surg J Open Forum 2019; 1:ojz007. [PMID: 33791603 PMCID: PMC7670936 DOI: 10.1093/asjof/ojz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Migraine disorders are a leading cause of morbidity and decreased economic productivity
in the United States among both men and women. As such, it is important to consider
patient opinions, and have an accurate representation of the burden and sentiment toward
currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the
various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet
crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered
to collect patient-reported opinions regarding adverse outcomes of both surgical and
nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied
slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per
month) experienced the fewest migraine and with the lowest severity. Those individuals
ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm).
Additionally, the greatest migraine frequency and severity existed among those
households with yearly income of $75,000–$100,000. The lowest injection therapy utility
scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40
mm). Conclusions Migraine headaches remains a significant problem among the US population, with an
overall prevalence of 15.6% (approximately 50 million Americans). Additionally,
physicians interesting in offering minimally invasive or surgical treatment for migraine
headaches should focus on mitigating patient fears regarding clinical outcomes and cost
of care.
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Affiliation(s)
- Orr Shauly
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Keck Hospital of University of Southern California, Los Angeles, CA
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Rounds AD, Burtt KE, Leland HA, Alluri RK, Badash I, Patel KM, Carey JN. Functional outcomes of traumatic lower extremity reconstruction. J Clin Orthop Trauma 2019; 10:178-181. [PMID: 30705556 PMCID: PMC6349574 DOI: 10.1016/j.jcot.2017.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/17/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear. HYPOTHESIS This study investigates functional outcomes following soft tissue reconstruction for open tibial fractures. MATERIALS AND METHODS A retrospective review of a prospectively maintained database of open tibia fractures requiring soft tissue reconstruction was performed at an urban level 1 trauma center between October 2013 and March 2015. OUTCOMES were evaluated using Pearson's chi square test with significant p value < 0.05. RESULTS In 30 patients, fractures were graded Gustilo-Anderson type I (3.3%), 30% type II, 3.3% type IIIa, 53.3% type IIIb, and 10% type IIIc. Fixation was 56.7% plate and screw, 20% intramedullary nail, and 16.7% external fixator. Definitive closure was achieved in 43.3% through local rotational flap (38.5% gastrocnemius, 61.5% soleus), and in 56.7% by free tissue transfer (29.4% latissimus, 23.5% rectus, 17.6% ALT, 17.6% gracilis). In 10 patients, 70% returned to full ambulation, 30% required an assistance device, and 50% achieved union in 6 months. Local flap use was predictive of ambulation at discharge. DISCUSSION Following lower extremity fracture, 70% of patients returned to pre-injury function. Use of a local tissue flap was associated with early ambulation.
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Affiliation(s)
- Alexis D. Rounds
- Keck School of Medicine of University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States,Corresponding author at: 1510 San Pablo St. Suite 415, Los Angeles, CA, United States.
| | - Karen E. Burtt
- Keck School of Medicine of University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States
| | - Hyuma A. Leland
- Department of Plastic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States
| | - Ram K. Alluri
- Department of Orthopedic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States
| | - Ido Badash
- Keck School of Medicine of University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States
| | - Ketan M. Patel
- Department of Plastic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States
| | - Joseph N. Carey
- Department of Plastic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States
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Shauly O, Gould DJ, Patel KM. Emerging nonsurgical and surgical techniques to treat erectile dysfunction: A systematic review of treatment options and published outcomes. J Plast Reconstr Aesthet Surg 2018; 72:532-538. [PMID: 30765240 DOI: 10.1016/j.bjps.2018.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/10/2018] [Accepted: 12/09/2018] [Indexed: 01/17/2023]
Abstract
Erectile dysfunction (ED) is one of the most common causes of morbidity in male patients, with a prevalence of 50-60% in men aged 40-70 years. EDs may be caused by physical or psychological trauma, the former of which may be treatable through surgical intervention. Physical trauma may be further categorized as vasculogenic, neurogenic, or idiopathic in nature. Although many patients do not respond well to nonsurgical treatment options, few opt for surgical intervention. This is likely due to the difficulty of the procedures, as well as relatively low historical success rates. As such, a systematic review of the literature was performed to identify novel surgical interventions for ED. A total of 19 manuscripts were included in this review, representing data of three minimally invasive approaches to ED treatment and seven novel surgical techniques. The data revealed compelling evidence in support of microsurgical treatments for ED - namely, microvascular arterial bypass penile revascularization surgery (MABS) and cavernous nerve graft reconstruction. Nerve grafts varied, with the use of end-to-side ilioinguinal, genitofemoral, and sural grafts, all demonstrating high rates of success. Furthermore, minimally invasive botulinum toxin (BoNT-A) treatment and adipose-derived stem cell (ADSC) therapy have shown extreme promise in rat models; with BoNT-A treatment entering phase II human clinical trials this year. Many of the surgical methods investigated in this review are microsurgical interventions that demonstrate high rates of success in patients with neurogenic or vasculogenic ED. As such, microsurgeons are uniquely trained and positioned to be of value to ED treatment.
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Affiliation(s)
- Orr Shauly
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States.
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45
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Vartanian ED, Lynn JV, Perrault DP, Wolfswinkel EM, Kaiser AM, Patel KM, Carey JN, Hsieh PC, Wong AK. Risk Factors Associated with Reconstructive Complications Following Sacrectomy. Plast Reconstr Surg Glob Open 2018; 6:e2002. [PMID: 30881800 PMCID: PMC6414132 DOI: 10.1097/gox.0000000000002002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sacral pathology requiring partial or total sacrectomy is rare, and reconstructing the ensuing defects requires careful decision-making to minimize morbidity. The purpose of this study was to review the experience of a single institution with reconstructing large sacral defects, to identify risk factors for suboptimal outcomes. METHODS A retrospective chart review was conducted of all patients who underwent sacrectomy over a 10-year period. Univariate analysis of differences in risk factors between patients with and without various postoperative complications was performed. Multivariate logistic regression was used to identify predictive variables. RESULTS Twenty-eight patients were identified. The most common diagnosis leading to sacrectomy was chordoma (39%). Total sacrectomy was performed on 4 patients, whereas 24 patients underwent partial resection. Reconstructive modalities included 15 gluteal advancement flaps, 4 pedicled rectus abdominis myocutaneous flaps, and 9 paraspinous muscle or other flap types. There was an overall complication rate of 57.1% (n = 12) and a 28.6% (n = 8) incidence of major complications. There were significantly more flap-related complications in patients who underwent total sacrectomy (P = 0.02). Large defect size resulted in significantly more unplanned returns to the operating room (P < 0.01). CONCLUSION Consistent with other published series', the overall complication rate exceeded 50%. Defect volume and sacrectomy type were the strongest predictors of postoperative complications and return to the operating room, while reconstructive strategy showed limited power to predict patient outcomes. We recommend that patients anticipated to have large sacral defects should be appropriately counseled regarding the incidence of wound complications, regardless of reconstructive approach.
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Affiliation(s)
- Emma D. Vartanian
- From the USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif
| | | | | | - Erik M. Wolfswinkel
- From the USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif
| | | | - Ketan M. Patel
- From the USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif
| | - Joseph N. Carey
- From the USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif
| | | | - Alex K. Wong
- From the USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif
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46
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De Romeri V, Patel KM, Valle JW. Inverse seesaw mechanism with compact supersymmetry: Enhanced naturalness and light superpartners. Int J Clin Exp Med 2018. [DOI: 10.1103/physrevd.98.075014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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47
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Bowen CM, Landau MJ, Badash I, Gould DJ, Patel KM. Primary tumors of the hand: Functional and restorative management. J Surg Oncol 2018; 118:873-882. [DOI: 10.1002/jso.25202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Chase M. Bowen
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Mark J. Landau
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
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48
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Gould DJ, Mehrara BJ, Neligan P, Cheng MH, Patel KM. Lymph node transplantation for the treatment of lymphedema. J Surg Oncol 2018; 118:736-742. [PMID: 30129675 DOI: 10.1002/jso.25180] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/05/2022]
Abstract
Lymphedema is a complex disease process with deranged lymphatic transport, fluid accumulation and secondary lipedema and fibrosis. This is a challenging disease to treat with a surgical focus on debulking and physiologic strategies. One strategy is the use of vascularized lymph node transplant (VLNT) to improve physiologic lymph clearance. In this article, VLNT is discussed in detail, including mechanisms, combined strategies, and outcomes.
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Affiliation(s)
- Daniel J Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, California
| | - Babak J Mehrara
- Department of Surgery, Plastic and Reconstructive Surgery, Service, Memorial Sloan-Kettering Cancer Center, New York
| | - Peter Neligan
- Department of Plastic Surgery, University of Washington Medical Center, Washington
| | - Ming-Huei Cheng
- Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Taiwan
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, California
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49
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Patel KM, Shauly O, Gould DJ. Introducing the subdermal free flap: Preserving the ultrathin-free skin flap option in morbidly obese patients. J Surg Oncol 2018; 118:403-406. [PMID: 30098306 DOI: 10.1002/jso.25144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/04/2018] [Indexed: 11/05/2022]
Abstract
In the morbidly obese population (BMI > 35), distal extremity defects are difficult to reconstruct. Traditional skin flaps are several centimeters in thickness in obese patients; however, a new plane superficial to the scarpal plane has demonstrated success in these patients. In this report, we present a 62-year-old female (BMI = 44.81) with a chronic lower extremity wound. A suprascarpal thin flap (approximately 1 cm in thickness) was harvested from the thigh and transferred successfully with no wound-healing issues.
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Affiliation(s)
- Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Orr Shauly
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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Abstract
Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.
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Affiliation(s)
- Mark V Schaverien
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck Medical Center of USC, University of Southern California, Los Angeles, California
| | - Jesse C Selber
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ming-Huei Cheng
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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